Let’s take a deep dive and explore the reasons for why Malaysian nurses are leaving the country in droves? Why would one leave their family, loved ones, security, and a tapestry rich in culture, tradition, food, comfort, to head overseas and pursue their career in nursing?
“Brain drain” refers to the migration of intelligent, skilled, and capable experts leaving in search of better work circumstances.
Beginning at SJMC in Malaysia in 1999
I hail from a small beach town in Malaysia called Port Dickson. I started my career in nursing in mid-1999 at the then College of Nursing Subang Jaya Medical Centre in Selangor. This was one of the premier private hospitals and I had been awarded a scholarship for a three-year diploma in nursing programme.
Upon completion of the diploma in 2002, I had to serve the organisation to fulfil my obligations for the scholarship, which was a five-year bond. During those five years, I was posted to the Coronary Care Unit (CCU) and very quickly understood how unequipped I was in terms of knowledge and skills to care for my patients. It was evident that I was on a very steep learning curve as a new graduate nurse.
Thankfully, nine months in, I was given the opportunity to pursue a post basic certificate in critical care nursing in the very same college. This further equipped me to work across the intensive care unit, neonatal unit, and coronary care unit. After which, I embarked on my degree in nursing (post registration) with Monash University.
Little did I know that the connection, and fate to head to Australia started way back then, in 2004. Upon completing my degree in nursing, I became a clinical instructor in the medical / surgical and VVIP ward and stayed on for exactly a year.
During that year, it dawned upon me that there must be more to nursing than just this. I felt that my progress in my career was slow, I knew I had more to give and learn, and by then, I had a rock-solid foundation in nursing and was ready to explore my options in the world.
Abu Dhabi, UAE: Consultant Doctors Called by Their First Name
I was successful with my application to Sheikh Khalifa Medical City in Abu Dhabi and was posted to the medical / surgical and neuro-surgical intensive care unit as a nurse specialist.
I was in total shock! The nurses called their consultants by their first name (no doctor title in front), the consultants would get up and offer you a his or her chair, the consultants and registrars took the time on rounds to greet you, include you in the discussions and would ask for your opinion regarding your patient’s management plan.
They respected you as a nurse and valued your input as a professional. You were never made to feel less important, but rather an integral part of the team. Something I had never experienced back home.
In Malaysia, I was once told off for not addressing an orthopaedic consultant with his title; I had addressed him as Dr X at the beginning of morning rounds. He immediately stopped in his tracks and looked and me and said, “Young lady, I am not Dr X; I’m Dato’ Dr X to you!” and continued to walk into the patient’s room.
This was certainly not the case here in Abu Dhabi. I caught myself thinking that it must be true – the various TV series, ER, Chicago Hope and later Grey’s Anatomy – where nurses, doctors and other multidisciplinary team members work together and challenge each other in a professional manner for best patient outcomes. It was simply exhilarating!
I was promoted three months in as the clinical resource nurse (nurse educator – unit based) for the intensive care unit. Six months after that, I was asked to lead hospital wide education courses and be the chair of the group.
After being there for two years and completing my executive master’s in business administration, I was itching to see what else the Middle East had to offer. You may be wondering why an EMBA and not a master’s in nursing? Well, being trained in a private hospital, it always baffled me as a junior nurse – what is morally and ethically right in nursing may not necessarily be a lucrative business decision. Where do I draw the line and how do I balance this as a nurse?
The EMBA taught me to think business; however, whenever I was given a chance, the assignment would be brought back to my familiar playground of hospitals and how nurses too can lead them.
Riyadh, Saudi Arabia: Mini Malaysia of Nurses
The next destination in 2010 was to King Abdulaziz Medical City – National Guard Hospital in Riyadh, Kingdom of Saudi Arabia, where I was employed as a Nurse Educator for hospital-wide courses. After a year, I was the nursing internship placement manager for about 150 nursing graduates from King Saud University.
This hospital was huge and renowned for performing highly skilled procedures which I only read in medical journals i.e. separation of conjoined twins, robotic surgery. and so on. Saudi is known for being an extremely rich yet conservative country – back then, no alcohol, no socialising with a member of the opposite sex, even restaurants had a family section and a male section.
No cinemas, no clubs, businesses would shut down during prayer time and females would have to wear the abaya, a long, black robe and a shawl to cover your head and hair when one was out of the hospital campus and staff accommodation complex and in the public eye.
The hospital grounds were so huge that they had several banks, their own shuttle service, sports and recreational facilities, and numerous coffee outlets. Within the hospital, there were golf buggies parked for staff utilise as transport from one end of the building to the other; and not forgetting the best shawarmas and falafels on earth!
It was also the place where I completed my PhD and forged friendships and bonds which are still strong to date with a handful of people. This was where I was valued, respected, and recognised as a professional. As one would expect, the pay was extremely generous (in comparison to Malaysia) and tax free.
This not only motivated and inspired me to dream big and achieve more goals, but it was also a place where I saw many fellow Malaysian nurses arriving in droves. Nurses had to leave their husband, children, and loved ones back home to earn what they should rightfully be paid and earn recognition for the work they do.
There was not an orientation group that went by every two weeks which did not have a Malaysian nurse or a few nurses in it. It was easy to spot them – they would sit together in a group and often moved around together. When I walked past them and said “Apa khabar?”, this brought a huge smile on their faces. A smile of relief and comfort.
It was blatantly obvious that there was a mini-Malaysia in the hospital, and I kid you not, Malaysian nurses are so well liked, respected, and welcomed in Saudi for their skills and knowledge. As the saying goes, “you can take the gal out of Malaysia, but you can never take the Malaysia out of the gal!”.
We would organise dinner parties and picnics for the festive season and yes, I’m referring to Raya Puasa, Raya Haji, Deepavali, Chinese New Year, Christmas, Merdeka Day, and birthdays. (basically, any reason to throw a party and share food). The tapestry of culture, tradition and food was ignited in Riyadh, Kingdom of Saudi Arabia. What more could one ask for?
Back to Malaysia: I Was ‘Overqualified’, Private Hospitals Couldn’t ‘Afford’ Me
Slightly more than two years later in 2013, I received a few calls from people whom I knew high up in management in Malaysia, asking me to return home, join the private hospitals and pursue my career in nursing leadership. This, of course, was because I had completed my EMBA and PhD.
I was hesitant at the beginning because I had always secured a job before leaving the current position and moving from one organisation to another. Nevertheless, I was told to return and attend a series of interviews, which was set up for me at a number of premier private hospitals in the Klang Valley and Melaka.
I went against my gut feeling and returned home to Malaysia, attended several interviews, and met a few directors of nursing and chief executive officers. They mentioned they were impressed; some even took me on a hospital tour and shared challenges that they were currently facing and I, in return, shared ideas I had learnt. They were all sounding positive and said, “We will be in touch to finalise the numbers and contract soon”.
Six months went by and not a sound from anyone. I had called and followed-up on a few of them and they had mentioned that I was overqualified for the job, and they could not afford to have me. Mind you, I was never approached for negotiations and was never asked for a salary range which I was interested in.
I was young, ambitious, and driven and this crippled me to the very core of my being. Why weren’t my blood, sweat and tears, the late-night study sessions, the invaluable experience, knowledge and skills gained after being away for five years in the Middle East not good enough for my Malaysia? Where did I go wrong? How can a nurse be taken seriously in the corporate world in Malaysia if he or she have not equipped themselves with the qualifications to back their experience?
Did I come across overconfident or rather cocky? I had answered their questions and was able to provide tangible solutions and share my views and experience at an international level with these people back home. But it was evident that that was not what those leaders were looking for.
It almost felt that they were intimidated by the enthusiasm and experience. Were these leaders intimidated by my qualifications? What were they looking for in a future nurse leader? Must I now lower my standards and expectations which I have worked extremely hard for just to fit in? How can there be progress if we are not challenged?
These questions kept spinning in my head for weeks and months until eventually I had to pick myself up, dust off my knees and move on. I had concluded that until and unless Malaysia sees nursing as a worthy profession in and amongst other health care professionals; recognises nurses for being the true backbone and heartbeat of its nation’s health care system; and is able to value nurses for the work that they do, Malaysia will continue to see a brain drain and not a brain gain. And I will have not have a bar of this ridiculous disposition.
Jeddah, Saudi Arabia: Learning How Not to Be a Leader
And so, I decided it was time to pack my bags again, this time aiming for a management position in the Middle East. I reached out to a nursing recruitment agency in Petaling Jaya then, Melorita and now Sehat Jobs, who were not only there to help guide me but also immediately secured me an interview with the Director of Nursing (DoN) of King Fahad Armed Forces Hospital in Jeddah, Kingdom of Saudi Arabia.
I spent 30 minutes with her, and she offered me a job as a head nurse (nurse manager) for the Cardiac Intensive Care Unit (22 beds), Paediatric Cardiac Intensive Care Unit (4 beds) and The Coronary Care Unit (24 beds). Needless to say, I was ecstatic! Off I went and very quickly, reality had set in.
This job was massive, and I was on a real steep learning curve yet again. The Director of Nursing’s expectations were very high, and I had struggled to achieve her goals mainly because the goal post kept shifting.
Nevertheless, I was not alone, my immediate line manager was a fellow Malaysian who cared and often met up with me after work to debrief.
There were often tears, followed by laughs because we told ourselves that we will not let her break our spirit and that we were learning how not to be leaders from her.
New Zealand: Paperwork to Be A Registered Nurse
It was then I decided to seriously explore the possibilities of moving to New Zealand. Why? Because I have heard so much about its spectacular scenic views and have always marvelled at the splendored of its nature and beauty.
Once I had decided, it shifted my focus, and I was even more motivated to get myself to New Zealand and call myself a New Zealand registered nurse. The sheer volumes of paperwork from certifications, attestation, reference letters from all hospitals I have ever worked in, to English language tests, vaccination records, and police clearance from every country I have lived in for the past 10 years was enough for anyone to give up and not pursue the matter further. However, I persevered and managed to tick the checklist off one at a time.
I had made my plans crystal clear to the DoN and as soon as my two-year contract was up, the timing could not have been better; I received an invitation to head to New Zealand to complete the final stage of my registration – the Competency Assessment Programme (CAP) which lasted three months.
I was posted to the Hawkes Bay District Health Board’s Emergency Department for the practical component and that was such an amazing experience. Very much in contrast to the Middle East in terms of systems and processes. Yet again, I found myself in an arena where nurses where respected, valued and treated as professionals.
I was often asked about my Malaysian heritage and why I had left home? I had to be honest – it was because I was ashamed and disappointed with how nurses were treated after being in places where nurses were valued and held in high esteem.
Although I successfully obtained my New Zealand nursing registration, the District Health Boards in New Zealand were undergoing a restructure then and recruitment was rather sluggish. It was then that an old colleague of mine reached out and advised me to obtain the Australian Health Practitioner Regulation Agency (AHPRA) registration.
The sheer idea that all health care professionals, regardless of speciality, needed to be registered with this single agency was proof enough that nurses were valued, respected, and seen as equals in Australia too. There was no need for doctors, pharmacists, physiotherapists, podiatrists, and nurses to have their individual agency for registration.
Within two weeks, I obtained my AHPRA registration and applied to a few hospitals, both in New Zealand and Australia. My journey was about to take an unexpected and unplanned course.
Central Australia: Now Acting Director of Nursing for the Critical Care, Perioperative Services and Patient Flow Division
Fate led me to Australia, and this was a connection made way back in 2004 from Monash University.
A small regional hospital smack in the middle of vast Australian outback desert called Alice Springs, spung up. I was interviewed and, within the week, I received an offer letter and visa sponsorship. I then decided to return to Malaysia to spend time with family before embarking on this new quest in the land down under.
When I returned to Malaysia, I was again asked to meet a few DoNs and CEOs, but I refused to do so. The goal was clear: I am never to return to where my profession is neither respected, nor valued. Doing so would be unjust to the profession and send leaders the wrong massage.
I know my worth and I am a nurse of international standards. Why on earth would I allow myself to stoop down to the bureaucracy and narrow-minded leaders who do not see my worth? This time, it was personal for me; I had to make this dream a reality – short term pain for long-term gain.
And so, on the 12th of May 2016, (196 years after Florence Nightingale’s birth), I landed in Alice Springs, Northern Territory as a registered nurse. Three months into the job, I was asked to act in the Nurse Manager role for the Continuing Care Ward, which later underwent a service realignment exercise and became the Orthopaedic & Rehabilitation Ward.
I won the permanent position for Nurse Management Consultant for the same ward a few months after acting in the position and got involved in numerous projects around the hospital – policy review and development, change management, Covid preparedness and activation, recruitment, leadership and management.
Now, I am the acting Director of Nursing for the Critical Care, Perioperative Services and Patient Flow Division. Many other nurses and I were presented with a plethora of opportunities to upskill and pursue our own professional development.
It is coming up to eight years here in Alice Springs. I have thoroughly enjoyed and will continue to enjoy this journey. This town, the hospital and team teams here have given me so much in so many ways and helped mould me into the nurse leader I am today.
I was also one of the three finalists in the 2023 Northern Territory Health Nursing & Midwifery Excellence Awards in the excellence in leadership category. It was such an honour and a privilege to be recognised on such a platform. I have since taken the Oath of Allegiance and become a proud Australian citizen. I obtained Australian citizenship in 2022, six years after I arrived for my nursing job in 2016.
Reasons Why Malaysian Nurses Leave the Country
In my opinion, this is multifactorial:
• Lack of respect for the profession in Malaysia.
• Lack of value for the profession in Malaysia.
• Bureaucracy, poor planning and execution of policies and procedures.
• Poor governance.
• Weak foundation, understanding, autonomy and advocacy of nursing leadership.
• Nursing in Malaysia is poorly rewarded in terms of remuneration.
• Rigidity or lack of flexibility in the work environment to empower nurses.
• Poor initiatives and incentives to grow your own by investing in their training and education.
• Not open to innovative ideas.
• Bullying in the workplace, especially when you seem to know more than your leader.
• Unsafe nurse to patient ratios.
• Poor work-life balance.
• Other health care professionals seem to trample all over nursing, yet this is openly accepted.
Below are some of the points that Malaysian nurses benefit from working abroad (Alice Springs, Australia):
• An opportunity to contribute to the delivery of quality health care.
• Be part of the community where you can see the difference you make.
• Exemplary clinical governance where the nurses have a strong say and exercise their rights for better pay and benefits via the Australian Nursing & Midwifery Foundation (ANMF) – Nursing Union.
• Foster a work-life balance with additional leave benefits (up to seven weeks’ annual paid annual leave a year) with annual leave loading bonus equivalent to 17.5 per cent of the value of annual recreation leave accrued during the previous year.
• Long service leave – three months paid leave after 10 years of continuous service.
• Excellent professional development opportunities with employed model programs, scholarships, and reimbursement models for study.
• Attractive salary scale with additional allowances for post graduate studies up to AU$5,589 annually. A registered nurse, depending on the number of years of experience, can earn between AU$76,305 to AU$101,612 annually. This does not include salary packaging up to AU$9,010 with additional AU$2,650 for meals and entertainment annually, shift responsibility allowances, weekend, and public holidays penalties. Attraction and retention bonuses up to AU$9,000 paid over two years.
• Flexible work arrangements where you can drop your hours to suit your lifestyle (casual – part time – full time); imagine having the freedom to work on your own terms.
• Recognition and respect from other health care professionals who pride themselves in working as a multidisciplinary team.
• An environment that fosters teamwork, challenging each other and thrives in innovation and thinking outside the box. An environment that nurtures their young and grows their leaders regardless of their gender, background, race, religion, and the country they originally came from. An environment that embraces and values diversity as its strength.
• An environment that includes and involves nursing at the very core of decision-making, legislation and policymaking, as well as management. Australian nurses are represented by their nursing unions who attend Parliament and lobby for their profession. The ANMF here is so strong due to its membership that they often manage to strong-arm politicians into agreeing with their log of claims who are developed by their members (the nurses). Other health care unions are in awe of what the ANMF can achieve.
These are just some of the reasons why Malaysia will continue to experience the brain drain phenomenon if they continue to be in deep slumber like in the past few decades. What has Malaysia done to attract and retain their nurses?
Does the answer lie in bringing in more foreign nurses? When will the Malaysian government be bold enough to admit their faults, pull apart the current system in pursuit of a radical reform, and restructure to fix the system once and for all? Until and unless this becomes a priority, the nursing brain drain will continue.
Tharumarani Tharumalingam, RN, BNg (PostReg), GardCertNg (Crit Care), Grad CertNg (Orthopaedic), DipLeadMgt, EMBA, PhD (Healthcare Management).
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
